GI and Oral

• Oral Cavity


  Includes diseases of teeth and supporting structures, oral inflammation, proliferative and neoplastic lesions, diseases of salivary glands, odontogenic cysts and tumors

  
• Dental Caries


  Most common cause of tooth loss in individuals < 35 years of age, primary cause is destruction of tooth structure by acid end products of sugar fermentation by bacteria

  
• Gingivitis


  Common and reversible inflammation of the mucosa surrounding the teeth, associated with buildup of dental plaque and calculus
• Periodontitis


  Chronic inflammatory condition that leads to destruction of the supporting structures of the teeth with eventual loss of dentition, associated with poor oral hygiene and altered oral microbiota

  
• Aphthous ulcers


  Painful superficial ulcers of unknown etiology, may in some cases be associated with systemic diseases
• Herpes Simplex Virus


  Causes a self-limited infection that presents with vesicles that rupture and heal, without scarring, and often leave latent virus in nerve ganglia, reactivation can occur
• Oral Candidiasis


  Occurs when oral microbiota is altered, such as after antibiotic use or in immunosuppressed individuals
• Fibroma


  • Submucosal nodular fibrous tissue masses, chronic irritation results in reactive connective tissue hyperplasia, located on buccal mucosa along the bite line
• Pyrogenic Granuloma


  • Inflammatory lesion found in gingiva, richly vascular and typically ulcerated, red to purple color, histologic: proliferation of immature vessels similar to granulation tissue
• Leukoplakia


  White patch or plaque that cannot be scraped off
• Erythroplakia


  Red, eroded lesion; flat or slightly depressed
• Risk factor for leukoplakia and erythroplakia is tobacco use
• Squamous Cell Carcinoma


  95% of cancers of the oral cavity, 5% are adenocarcinoma of salivary glands, related to HPV (oropharynx), early stage: raised, firm, pearly plaques, roughened, mucosal thickenings, histologic pattern ranges from well-differentiated keratinizing neoplasms to anaplastic
• Xerostomia


  Dry mouth resulting from a decrease in the production of saliva, can be caused by Sjogren syndrome
• Sialadenitis


  Inflammation of salivary glands, can be caused by trauma, infection or autoimmune reaction, most common viral form is mumps, most frequent bacterial pathogens are Staph aureus and Strep viridans
• Salivary gland neoplasms


  • 2% of all salivary gland tumors, 65-80% occur in the parotid gland, 10% occur in the submandibular gland, 15-30% of parotid gland tumors are malignant
• Pleomorphic adenoma


  Slow growing neoplasm composed of a heterogenous mixture of epithelial and mesenchymal cells, benign
• Mucoepidermoid carcinoma


  Malignant neoplasm composed of a mixture of squamous and mucous cells
• Odontogenic keratocyst


  Locally aggressive, with a high recurrence rate
• Periapical cyst


  Reactive, inflammatory lesion associated with caries or dental trauma
• Most common odontogenic tumors

  • Ameloblastoma
  • Odontoma
• Esophagus


  Includes obstructive and vascular diseases, esophagitis, and esophageal tumors

  
• Mechanical Obstruction


  Includes atresia, fistula, agenesis, stenosis
• Functional Obstruction


  Includes esophageal dysmotility, achalasia (triad of incomplete lower esophageal sphincter relaxation, increased LES tone, and esophageal aperistalsis)
• Ectopia


  Upper third of esophagus (Inlet patch), small bowel (Gastric heterotopia)

  
• Esophageal Varices


  Impede portal blood flow and cause portal hypertension, leading to bleeding
• Mallory-Weiss tears


  Most common esophageal lacerations, induced by severe retching or vomiting
• Esophageal infections


  HSV, CMV, Fungal organisms (Candida)
• Reflux Esophagitis


  Reflux of gastric contents into the lower esophagus, most common GI disease in outpatient setting in US, Gastroesophageal reflux disease (GERD) is most common >40 years of age
• Eosinophilic Esophagitis


  Chronic immunologically mediated disorder, symptoms: dysphagia and food impaction, histologic findings: epithelial infiltration by eosinophils, endoscopy: circumferential rings in the proximal esophagus
• Barrett Esophagus


  Complication of Chronic GERD, intestinal metaplasia within the esophageal squamous mucosa, increased risk for development of esophageal adenocarcinoma, histopathology findings: presence of goblet cells, distinct mucous vacuoles, dysplasia
• Esophageal Adenocarcinoma


  Associated with long-standing GERD and Barrett esophagus, occurs in the distal third of the esophagus and adjacent gastric cardia
• Esophageal Squamous Cell Carcinoma

  Associated with alcohol and tobacco use, poverty, caustic esophageal injury, achalasia
• Gastropathy and Acute Gastritis


  Gastritis results from mucosal injury, acute gastritis has neutrophils, gastropathy has cell injury and regeneration +/- inflammatory cells, stress ulcers occur in shock, sepsis, trauma patients, Curling ulcers occur in the proximal duodenum in burn and trauma patients, Cushing ulcers occur in the stomach, duodenum, esophagus with intracranial disease
• Chronic Gastritis


  Most common cause is Helicobacter pylori, can also be caused by autoimmune gastritis or chronic NSAID use, leads to intestinal metaplasia, gastric atrophy, reduced serum pepsinogen I, antral endocrine cell hyperplasia, vitamin B12 deficiency, and impaired gastric acid secretion
• Peptic Ulcer Disease


  Associated with H. pylori or NSAID use, gastric acid is fundamental to the pathogenesis, can occur in the stomach or duodenum, complication is perforation
• Inflammatory and hyperplastic gastric polyps


  Associated with chronic gastritis
• Gastric adenomas


  Associated with intestinal metaplasia and mucosal (glandular) atrophy
• Primary gastric lymphomas


  Derived from the mucosa-associated lymphoid tissue whose development is induced by chronic gastritis
• Gastric adenocarcinomas


  Most common, associated with H. pylori infection, classified according to location and gross and histologic morphology, intestinal histologic pattern tend to form bulky tumors and may be ulcerated, diffuse infiltrative growth pattern that may thicken the gastric wall (linitis plastica) without forming a discrete mass